Correlation of Parasite Load Determined by Quantitative PCR to Clinical Outcome in a Heart Transplant Patient with Disseminated Toxoplasmosis▿

Disseminated toxoplasmosis is a life-threatening infection in transplant recipients, which results either from reactivation of latent infection or from organ-transmitted primary infection. Preventive measures and diagnostic screening methods differ between countries and are related to the seroprevalence of Toxoplasma spp. in the general population. Here we report a case of disseminated toxoplasmosis in a heart transplant recipient with previous immunity that occurred after cotrimoxazole prophylaxis for the prevention of Pneumocystis jirovecii pneumonia was stopped. Quantitative PCR proved useful for the diagnosis and monitoring of Toxoplasma infection. Decreasing parasitic burdens in sequential samples of cerebrospinal fluid, blood, and bronchoalveolar lavage fluid correlated with a favorable outcome and allowed modulation of the immunosuppressive drug regimen. The duration of anti-Toxoplasma treatment and the need for maintenance prophylaxis are discussed, as well as prophylaxis for solid-organ transplant recipients. Although a rare event in heart transplant recipients, Toxoplasma reactivation must be investigated promptly, since early treatment improves the prognosis

Characteristics and prognosis of pneumococcal endocarditis: a case-control study

International audienceCase series have suggested that pneumococcal endocarditis is a rare disease, mostly reported in patients with comorbidities but no underlying valve disease, with a rapid progression to heart failure, and high mortality. We performed a case-control study of 28 patients with pneumococal endocarditis (cases), and 56 patients with non-pneumococcal endocarditis (controls), not matched on sex and age, during years 1991-2013, in one referral center. Alcoholism (39.3% vs. 10.7%; P<.01), smoking (60.7% vs. 21.4%%; P<.01), the absence of previously known valve disease (82.1% vs. 60.7%; P=0.047), heart failure (64.3% vs. 23.2%; P<.01), and shock (53.6% vs. 23.2%; P<.01) were more common in pneumococcal than in non-pneumococcal endocarditis. Cardiac surgery was required in 64.3% of patients with pneumococcal endocarditis, much earlier than in patients with non-pneumococcal endocarditis (mean time from symptoms onset, 14.1 ± 18.2 vs. 69.0 ± 61.1 days). In-hospital mortality rates were similar (7.1% vs. 12.5%). Streptococcus pneumoniae causes rapidly progressive endocarditis requiring life-saving early cardiac surgery in most case

Cytokine changes in sickle-cell disease patients as markers predictive of the onset of delayed hemolytic transfusion reactions

International audienceBackground: Changes in cytokine production are known to contribute to the pathogenesis of sickle-cell disease (SCD), particularly in painful acute complications (crises) and episodes of post-transfusion hemolysis. Little is known about cytokine profiles in patients with these complications.Study design and methods: We investigated possible associations between cytokine profile and the onset of delayed hemolytic transfusion reactions (DHTRs), particularly during acute-phase episodes, to improve characterization of the biological parameters predictive of such events. We included SCD patients with severe acute symptoms (n = 36) or steady-state disease (n = 31), both possibly leading to a DHTR (n = 18) event. Luminex® technology was used to determine the plasma concentrations of 23 cytokines.Results: Regardless of clinical context, the concentrations of interleukin (IL)-6, IL-10, inducible protein-10, and macrophage inflammatory protein-1β were higher in plasma samples from SCD patients than in those from healthy controls. IL-6 and IL-10 concentrations were even higher in acute-phase plasma samples from SCD patients. In addition, IL-27 and TNFα levels were higher, and IL-6 and RANTES levels were lower in acute-phase SCD patients just before the onset of DHTR than in patients experiencing painful occlusive episodes.Conclusion: In addition to reporting the plasma cytokine profiles of SCD patients in various clinical phases of the disease, we provide the first evidence of a significant association between low plasma TNFα concentration, high plasma IP-10 concentration and the onset of DHTR in SCD patients

VICTEAMS: a virtual environment to train medical team leaders to interact with virtual subordinates

International audienceHealth care delivery in military conflict, in peacekeeping missionsor in the aftermath of disaster, implies high stress environmentswith danger exposures, life-threatening events and high levels ofwork demand. Crisis and emergency risk communication remainsa real challenge. The rapid response of emergency medical teamshas an important role to play in preventing serious adverse events.During critical events, medical errors can be related to human or systemfactors, including ineffective team leadership, non-standardizedteam communication, a lack of global situation awareness, pooruse of resources and inappropriate triage and prioritization. TheVICTEAMS project aims at building a virtual environment for trainingrescue team leaders to non-technical skills. Depending on theleader abilities, the virtual characters playing the subordinates (e.g.nurses) reproduce a variety of behaviors like erroneous actions,followership attitudes or stress-based behaviors. A pedagogical directortailors the difficulty according to the dynamic profile of thelearner

Influence of infrastructure material composition and microtopography on marine biofilm growth and photobiology

International audienceThe impact of concrete composition and roughness on the formation of microalgal biofilms and their photobiology were studied on marine infrastructures presenting four different compositions combined with two degrees of roughness (rough and smooth). The structures were first inoculated with a natural microphytobenthic biofilm and immersed in sterilised seawater with a controlled photoperiod for six days. Photosynthetic activity was assessed with an imaging PAM-(Pulse Amplitude Modulated) fluorometer and microtopography was monitored in parallel with a 3-D camera. The results indicated that roughness had an impact on the biofilm biomass, its physiological status and its photosynthetic efficiency and capacity. The assessment of surface roughness indicated that negative reliefs were preferably colonised by MPB (microphytobenthic) cells with better photosynthetic performances. Moreover, MPB biofilms showed better photoacclimation in these microhabitats than on the positive and smooth reliefs. This study confirms the importance of microhabitat for biofilm formation and their photobiology